AB0583 REFERRAL PATTERN AND TREATMENT OF POLYMYALGIA RHEUMATICA IN GENERAL PRACTICE: AN INTERNATIONAL QUESTIONNAIRE BASED STUDY
Authors: A. Overgaard Donskov, S. Mackie, E. M. Hauge, C. Toro Gutiérrez, A. Hemmig, A. Van der Maas, B. Dalsgaard Nielsen, I. Hansen, M. Yates, L. Frølund, K. Douglas, K. Van der Geest, E. Rezus, S. Monti, M. Gromova, V. Ocampo, S. Appenzeller, M. Erraoui, A. Ajibade, A. Marun Lyrio, R. Grainger, M. Sandovici, T. Helliwell, E. Brouwer, C. Dejaco, K. Keller
Journal: Annals of the Rheumatic Diseases (2022)

Background In most countries polymyalgia rheumatica (PMR) is diagnosed and managed by both general practitioners (GP) and rheumatologists. However, the referral pattern from GP’s to specialist around the world has not been described. The initial prednisolone dose recommended by EULAR/ACR is between 12.5 and 25 mg 1 , but little is known about whether these guidelines are followed everywhere by GP’s in clinical practice 2 . Objectives This study aims to describe the refererral pattern and treatment strategy for PMR in general practice in several countries worldwide. Methods An English language questionnaire was drafted by a working group of rheumatologists and GP’s from 6 different countries. The questionnaire contained questions on: 1: Respondent, 2: Referral pattern and 3: Prednisolone. Questionnaires were distributed to GP’s via members of the International PMR/GCA study group. Answers were collected via an online survey tool (Redcap), from 3 rd of November 2021 to 27 th of January 2022. Countries with more than 15 responders to the questionnaire were included in the analysis. Results Data from 11 countries were analysed. Referral patterns differed widely among countries (Table 1). Almost all patients initially seen by rheumatologists were returned to GP’s for treatment. In all countries a proportion of the GP’s prescribed higher initial prednisolone doses than recommended, with a large variation between countries (Table 1). Table 1. Characteristics of responders, referral pattern, and treatment strategy Austria Canada Colombia Denmark Italy Nether-lands New Zealand Romania Russia Switzer-land United Kingdom Responders Responders (n), Completed questionnaire (total) 26 (29) 15 (15) 17 (23) 53 (53) 36 (41) 22 (22) 17 (17) 37 (43) 42 (49) 26 (26) 34 (35) Experience (years) 20 (12-34) 8 (4-10) 6 (4-9) 12 (10-17) 15 (5-27) 23 (17-30) 14 (9-27) 21 (16-30) 6 (5-9) 26 (15-32) 16 (11-24) Available PMR/GCA guideline, n (%) 26 (100) 15(100) 17 (100) 53 (100) 36 (100) 22 (100) 17 (100) 37 (100) 42 (100) 26 (100) 34 (100) Adherence to guideline, n (%) 21 (82) 15 (100) 17 (100) 51 (97) 34 (94) 21 (95) 17 (100) 37 (100) 42 (100) 26 (100) 34 (100) Referrals New PMR patients referred for diagnose (%) 58 (10-100) 50 (2-100) 100 (13-100) 50-(20-100) 60 (28-100) 20 (10-50) 10 (10-20) 60 (10-88) 1 (1-2) 28 (10-50) 10 (1-25) Patients returned to GP for treatment (%) 100 (50-100) 50 (2-100) 8 (0-50) 85 (40-100) 50 (0-100) 50 (10-90) 100 (90-100) 80 (50-98) 1 (1-1) 80 (10-100) 100 (100-100) Patients referred during treatment (%) 50 (25-90) 50 (10-100) 100 (50-100) 20 (10-33) 50 (15-80) 15 (10-30) 20 (10-25) 30 (10-80) 1(1-1) 20 (10-30) 10 (10-20) Prednisolone Initial dose (mg) 38 (25-50) 20 (20-50) 20 (10-30) 25 (15-40) 25 (25-25) 15 (15-15) 20 (15-40) 15 (12-20) 15 (15-15) 50 (25-50) 15 (15-20) Initial dose &gt; 25 mg, n (%) 12 (47) 4 (25) 7 (40) 14 (26) 9 (25) 1 (5) 6 (38) 7 (20) 3 (8) 22 (83) 3 (9) Duration of treatment (months) 9 (6-12) 6 (2-9) 6 (4-24) 12 (8-18) 5 (3-12) 11 (6-12) 12 (10-18) 2 (2-5) 6 (6-6) 12 (12-14) 15 (12-24) Data are presented as weighted median (interquartile range) unless otherwise stated. GP: general practitioner, PMR: polymyalgia rheumatica, GCA: great cell arteritis. Conclusion Although many patients were referred to the hospital for initial PMR diagnosis or during the disease course, a large proportion of patients received treatment in general practice worldwide. GPs frequently use a higher starting dose of prednisolone and shorter treatment duration than recommended by EULAR/ACR. References [1]Dejaco C, Singh YP, Perel P, et al. 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Annals of the rheumatic diseases 2015; 74 (10): 1799-807. [2]Helliwell T, Hider SL, Mallen CD. Polymyalgia rheumatica: diagnosis, prescribing, and monitoring in general practice. The British journal of general practice: the journal of the Royal College of General Practitioners 2013; 63 (610): e361-6. Acknowledgements This study was endorsed by the international PMR/GCA study group. Disclosure of Interests Agnete Overgaard Donskov: None declared, Sarah Mackie: None declared, Ellen-Margrethe Hauge Speakers bureau: AbbVie, Sanofi, Sobi, MSD, UCB, Consultant of: AbbVie, Sanofi, Sobi, MSD, UCB, Grant/research support from: Novo Nordic Foundation, Danish Rheumatism Association, Danish Regions Medicine Grants, Roche, Novartis,Celgene, MSD, Pfizer, Roche, Sobi, CARLOS TORO GUTIÉRREZ: None declared, Andrea Hemmig: None declared, Aatke van der Maas: None declared, Berit Dalsgaard NIelsen Paid instructor for: Roche, Ib Hansen: None declared, Max Yates: None declared, Line Frølund: None declared, Karen Douglas: None declared, Kornelis van der Geest Speakers bureau: Roche, Elena Rezus: None declared, Sara Monti: None declared, Margarita Gromova: None declared, Vanessa Ocampo Speakers bureau: Abvie, Simone Appenzeller Speakers bureau: Janssen, UCB, Lilly and Pfizer, Mariama Erraoui: None declared, Adeola Ajibade: None declared, Andre Marun Lyrio: None declared, Rebecca Grainger: None declared, Maria Sandovici: None declared, Toby Helliwell: None declared, Elisabeth Brouwer Speakers bureau: Roche, Consultant of: Roche, Christian Dejaco Speakers bureau: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Galapagos and Sanofi, Consultant of: Abbvie, Eli Lilly, Janssen, Roche, Galapagos and Sanofi, Kresten Keller: None declared